Digital Training Approaches for Family Planning Clients and Health Workers

Connecting solutions for education and empowerment

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Beth Balderston
Communications Officer

Implementation Partners

PATH (lead)
Ministries of Health in Senegal and Uganda (collaborators, host countries)
John Snow, Inc. (collaborator)


Bill & Melinda Gates Foundation
Children’s Investment Fund Foundation

Implementation Dates

2018 - present

Geographic Scope

Uganda, Senegal

Target Users

Client, Health Care Provider

Enabling Environment Building Blocks


Family Planning Program Classification

Service Delivery


Training and supervising health workers is one of the biggest challenges and cost drivers when introducing and bringing to scale a new contraceptive method or service delivery innovation.

Traditional in-person trainings bring together health workers for multi-day events, which typically include both classroom and practical hands-on training. This approach can require thousands of dollars for per diem, travel, materials, facilitation fees, and room rentals.

Moreover, off-site trainings can leave facilities short-staffed, resulting in delays in service delivery while providers are in training. In-country scale-up plans for the injectable contraceptive subcutaneous DMPA (DMPA-SC), training is the highest-cost activity—often representing 50 percent or more of costs.

Contraceptive self-injection has received strong endorsement from the World Health Organization as a self-care intervention that can both alleviate burdens on health systems and empower women to manage their own health. Yet, while having clients self-inject DMPA-SC is an effective task-shifting strategy in the long run, health workers must find time up front in their busy schedule to counsel and coach clients who are new to the practice.

In response to the pressing need for more affordable training approaches that maintain quality of care, PATH has developed digital training resources for both DMPA-SC self-injection clients and health workers who provide family planning and are learning to offer DMPA-SC as an option amid a wide range of contraceptive methods in private, public, or community-based sectors.

Project/Digital Health Solution Overview

PATH, in collaboration with John Snow, Inc., produced short five- to seven-minute training videos for both self-injection clients and health workers learning to administer DMPA-SC. Available in English and French, these videos are intended to complement any training approach. The script and video files are also available for translation or adaptation to fit specific program contexts. To date, the videos have been used and adapted in several countries, including Mauritania, Nigeria, Senegal, Uganda, and Zambia.

In addition to the videos, PATH has developed an eLearning course designed for health workers who are learning to offer DMPA-SC. The course is based on PATH’s original classroom-based curriculum that has been used for many years to train health workers with diverse levels of expertise. The online course is available in English and French and can be taken on computer, tablet, or mobile phone with internet access. Participants can either take the full 10 lessons or the individual lesson on counseling clients on self-injection. Interactive exercises, resources, and job aids are included throughout the course to help learners engage with the information. Participants are required to pass quizzes on individual lessons and a final quiz to earn the course certificate of completion.

Both the training videos and eLearning course are designed for clients and health workers across sectors, including public facilities, private clinics, pharmacies, or drug shops. They are also intended for use in the context of an in-person orientation, such as a counseling session for clients or a hands-on practicum for health workers before they are authorized to administer injections to clients.

Evaluation and Results Data

While digital training approaches have great potential to facilitate DMPA-SC training worldwide, limited information is available on their implementation in low-resource settings. To learn more about whether and how these approaches could be effective, we conducted an evaluation of clients learning to self-inject using the video in Uganda. In Uganda and Senegal, we are currently conducting evaluations of our eLearning course.

Video self-training study with clients

The self-training study evaluated client’s self-injection competency after watching the five-minute video compared to those who learned with a two-page printed self-injection job aid  We randomly assigned either the video or job aid to 200 women who were clients in public clinics (n=101), private clinics (n=38), pharmacies (n=24), or drug shops (n=37) across five districts in Uganda. After self-training, clients demonstrated how to inject on a model; as this was a proof of concept, no actual self-injecting took place.

Overall, clients found the video easier to follow when accompanied with the printed job aid. In both the video and job aid groups, over half of clients reported feeling “very prepared” to demonstrate the injection, were generally satisfied with self-training (video clients more so), and said they would recommend it to their friends.[5]

Across sectors, clients who self-trained with the video had higher competence (71 percent) than those who used the job aid (36 percent). In the public sector, clients who watched the video were more likely to correctly calculate reinjection dates. Private sector clients had higher competency than public sector clients whether they self-trained with the job aid or the video.

eLearning evaluation with health workers

After an initial round of pretesting and revisions to the eLearning course based on health worker input, we are evaluating the DMPA-SC eLearning course in select parts of Uganda and Senegal in collaboration with the ministries of health. This evaluation aims to determine whether the approach is effective, feasible, and cost-efficient; for whom the approach works well and for whom it does not; and what the facilitators and barriers are for successful application of eLearning as a family planning training approach. The evaluation is currently underway in Uganda, with results expected mid-2020. The evaluation in Senegal is anticipated to begin in mid-2020.

Lessons Learned

  • Access to technology continues to be a barrier in low-resource settings. Despite the growing reach of technology, both family planning clients and health workers may not have access to the necessary technology to access digital training interventions.
  • Often developers in higher-income settings are not familiar with low-connectivity settings and need to be sensitized; input from local users is also crucial. Whenever possible, digital training approaches should allow for offline or low-bandwidth use.
  • Users’ literacy levels, including digital literacy, is a key factor to consider when introducing digital training interventions approaches. In our self-training exercise, private sector clients were more educated and had higher injection competency than public sector clients, whether trained with the job aid or the video.
  • Traditional training approaches still play a role in digital training. Even clients who used the video to self-train expressed a preference for the printed job aid as their at-home support after training.


Our experience introducing digital training has shown great potential to help reduce the costs, time, and inconvenience associated with traditional training approaches in family planning programs. To date, both clients and health workers have expressed satisfaction with these interventions, and there is growing evidence indicating their effectiveness.

Before introducing any digital training innovation, a deep understanding of the anticipated context of use is crucial. Accounting for key factors—such as access to devices, connectivity, and users’ familiarity with digital platforms—as early as possible during the development process is more likely to lead to success.


  1. The power to prevent pregnancy in women’s hands: DMPA-SC injectable contraception. Accessed March 3, 2020.
  2. World Health Organization (WHO). WHO consolidated guideline on self-care interventions for health: sexual and reproductive health and rights. Geneva: WHO; 2019.
  3. DMPA-SC training videos for family planning clients and health workers. Accessed March 3, 2020.
  4. Pandit-Rajani, T; Bock A, Bwembya M, Banda L. The Next Generation Injectable, A Next Generation Approach: Introducing DMPA-SC Self-Injection Through Private Providers in Zambia. Arlington, VA: Advancing Partners and Communities Project; and Zambia: USAID/DISCOVER-Health Project, JSI Research & Training Institute, Inc.; 2019.
  5. PATH. Self-training activity survey results: Self-injection Best Practices study. Seattle: PATH; 2019.